International Orthopaedics

, Volume 42, Issue 4, pp 829–834 | Cite as

Reconstruction for chronic Achilles tendinopathy: comparison of flexor hallucis longus (FHL) transfer versus V-Y advancement

  • Jackson R. Staggers
  • Kenneth Smith
  • Cesar de C. Netto
  • Sameer Naranje
  • Krishna Prasad
  • Ashish ShahEmail author
Original Paper



Several operative techniques exist for Achilles tendinopathy. The purpose of our study was to compare the clinical and functional outcomes of flexor hallucis longus (FHL) transfer and V-Y advancement for the treatment of chronic insertional Achilles tendinopathy.


Retrospective chart review from 2010 to 2016 of patients that underwent FHL transfer or V-Y advancement for chronic insertional Achilles tendinopathy. Outcome measures were compared for these two procedures.


In total, 46 patients (49 ankles) with a mean age of 55.0 (range 33–73) years. Mean follow-up time 44.7 +/− 25.5 months. FHL group had 21 patients (21 ankles) with 89% satisfaction, 14% complication rate, final VAS of 0.4, final VISA-A of 89.1, subjective strength improvement following surgery of 78%, and 94% would recommend the procedure. V-Y group had 25 patients (28 ankles) with 74% subjective satisfaction, 21% complication rate, final VAS of 1.4, final VISA-A of 78.4, subjective strength improvement following surgery of 67%, and 84% would recommend the procedure. There was no significant difference in any of the results rates between the two groups (p > .05).


V-Y advancement is comparable to FHL transfer for the operative management of insertional Achilles tendinopathy. Though our results trend towards less satisfactory results following V-Y advancement, we found high satisfaction rates with similar functional outcomes and complication rates in both operative groups. We suggest considering V-Y advancement as a viable option for the primary treatment of chronic insertional Achilles tendinopathy in patients who may not be an ideal candidate for FHL transfer.


Achilles tendinopathy Flexor hallucis longus V-Y advancement 



This work was presented at the Alabama Orthopaedic Society (AOS) 2017 but never published in the final form. We would also like to thank Girish Motwani, M.D., for his contributions to this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Institutional review board approval was obtained prior to this study.

Informed consent

For this type of study, formal consent was not required.


  1. 1.
    Rahm S, Spross C, Gerber F et al (2013) Operative treatment of chronic irreparable Achilles tendon ruptures with large flexor hallucis longus tendon transfers. Foot ankle Int 34:1100–1110. CrossRefPubMedGoogle Scholar
  2. 2.
    Hunt KJ, Cohen BE, Davis WH et al (2015) Surgical treatment of insertional Achilles tendinopathy with or without flexor Hallucis longus tendon transfer: a prospective, randomized study. Foot ankle Int 36:998–1005. CrossRefPubMedGoogle Scholar
  3. 3.
    DeOrio MJ, Easley ME (2008) Surgical strategies: insertional Achilles tendinopathy. Foot Ankle Int 29:542–550. CrossRefPubMedGoogle Scholar
  4. 4.
    Wapner KL, Pavlock GS, Hecht PJ et al (1993) Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer. Foot Ankle 14:443–449CrossRefPubMedGoogle Scholar
  5. 5.
    Silver RL, de la Garza J, Rang M (1985) The myth of muscle balance. A study of relative strengths and excursions of normal muscles about the foot and ankle. J Bone Joint Surg Br 67:432–437CrossRefPubMedGoogle Scholar
  6. 6.
    Kissel CG, Blacklidge DK, Crowley DL (1994) Repair of neglected Achilles tendon ruptures—procedure and functional results. J Foot Ankle Surg 33:46–52PubMedGoogle Scholar
  7. 7.
    Abraham E, Pankovich AM (1975) Neglected rupture of the Achilles tendon. Treatment by V-Y tendinous flap. J Bone Joint Surg Am 57:253–255CrossRefPubMedGoogle Scholar
  8. 8.
    Ponnapula P, Aaranson RR (2010) Reconstruction of Achilles tendon rupture with combined V-Y Plasty and gastrocnemius-soleus fascia turndown graft. J Foot Ankle Surg 49:310–315. CrossRefPubMedGoogle Scholar
  9. 9.
    Elias I, Besser M, Nazarian LN, Raikin SM (2007) Reconstruction for missed or neglected Achilles tendon rupture with V-Y lengthening and flexor hallucis longus tendon transfer through one incision. Foot ankle Int 28:1238–1248. CrossRefPubMedGoogle Scholar
  10. 10.
    Carlsson AM (1983) Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 16:87–101. CrossRefPubMedGoogle Scholar
  11. 11.
    Robinson JM, Cook JL, Purdam C et al (2001) The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 35:335–341. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Tashjian RZ, Hur J, Sullivan RJ, Campbell JT (2003) Flexor hallucis longus transfer for repair of chronic Achilles tendinopathy. Foot Ankle Int 24:673–676. CrossRefPubMedGoogle Scholar
  13. 13.
    Schon LC, Shores JL, Faro FD et al (2013) Flexor hallucis longus tendon transfer in treatment of Achilles tendinosis. J Bone Jt Surg Am 95:54–60. CrossRefGoogle Scholar
  14. 14.
    Monroe MT, Dixon DJ, Beals TC et al (2000) Plantarflexion torque following reconstruction of Achilles tendinosis or rupture with flexor hallucis longus augmentation. Foot ankle Int 21:324–329. CrossRefPubMedGoogle Scholar
  15. 15.
    Wilcox DK, Bohay DR, Anderson JG (2000) Treatment of chronic Achilles tendon disorders with flexor hallucis longus tendon transfer/augmentation. Foot Ankle Int 21:1004–1010. CrossRefPubMedGoogle Scholar
  16. 16.
    Martin RL, Manning CM, Carcia CR, Conti SF (2005) An outcome study of chronic Achilles tendinosis after excision of the Achilles tendon and flexor hallucis longus tendon transfer. Foot Ankle Int 26:691–697. CrossRefPubMedGoogle Scholar
  17. 17.
    Cottom JM, Hyer CF, Berlet GC, Lee TH (2008) Flexor hallucis tendon transfer with an interference screw for chronic Achilles tendinosis: a report of 62 cases. Foot Ankle Spec 1:280–287. CrossRefPubMedGoogle Scholar
  18. 18.
    McCormack J, Underwood F, Slaven E, Cappaert T (2015) The minimum clinically important difference on the VISA-A and LEFS for patients with insertional Achilles tendinopathy. Int J Sports Phys Ther 10:639–644PubMedPubMedCentralGoogle Scholar
  19. 19.
    Iversen JV, Bartels EM, Langberg H (2012) The Victorian institute of sports assessment-Achilles questionnaire (VISA-A)—a reliable tool for measuring Achilles tendinopathy. Int J Sports Phys Ther 7:76–84. PubMedPubMedCentralGoogle Scholar
  20. 20.
    Sayana MK, Maffulli N (2007) Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy. J Sci Med Sport 10:52–58. CrossRefPubMedGoogle Scholar
  21. 21.
    Coull R, Flavin R, Stephens MM (2003) Flexor hallucis longus tendon transfer: evaluation of postoperative morbidity. Foot ankle Int 24:931–934. CrossRefPubMedGoogle Scholar
  22. 22.
    Hoenig JM, Heisey DM (2001) The abuse of power: the pervasive fallacy of power calculations for data analysis. Am Stat 55:19–24. CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.University of Alabama at BirminghamBirminghamUSA

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